Economic Impacts of Vaccinations and Immunizations

Vaccines have greatly changed the health and lives of people around the world since their development in the 18th century. Vaccines refer to the use of antigens to enhance immunity or susceptibility to a single disease (Romm 1). On the other hand, immunization is the mechanism by which people are protected from illness. Vaccination and immunization are used interchangeably. The antigen improves or eliminates the effects of infections caused by pathogens. Vaccines also eradicated some of the deadliest diseases and stopped them from returning, thereby saving the health of countless people. However, some people still doubt the safety of the vaccines, thus, hampering the complete eradication of some diseases such as polio. Those opposed to vaccination believe that they cause autism. Such individuals request to be exempted from compulsory vaccinations. Unfortunately, such exemptions increase risks of infections.

The length of life of an individual partly depends on the availability of affordable and quality health care services. Vaccinations and immunizations are the most cost-effective and fruitful medical interventions ever developed. A report from the U.S. Centers for Disease Control and Prevention indicate that this peculiarity still holds. The report revealed that vaccines prevented more than 322 million illnesses, about 732,000 premature deaths, and nearly 21 million hospitalizations for children born between 1994 and 2013 in the U.S. (Rappuoli 12282). The vaccines also saved nearly $295 billion direct medical and a total cost of $1.38 trillion for the society over the same period. Therefore, despite some claims that vaccinations cause autism, they promote longevity of the community by protecting people from deadly diseases, prevent mortality, and empower families economically.

Health Impacts of Vaccinations on Humans

Vaccines have significantly changed the health of many people all over the world for decades by preventing people from deadly diseases. Some of the common illnesses which can be avoided through vaccination include diphtheria, human papillomavirus, mumps, hepatitis, rubella, tetanus, and polio. Other diseases include varicella, pneumococcal, pertussis, and rotavirus. Neustaedter emphasizes that vaccinations are essential because they protect people and keep them from dying, thus, prolonging societal life (1-2). This is an important observation because vaccines do not only prevent people from getting diseases but also from passing them to others.

Vaccination prolongs societal life by controlling diseases in various ways.

Diseases Eradication

Vaccines eradicate some of the target pathogens completely, thus, not only protecting users but also lengthening their lives. For instance, the use of vaccines has eradicated smallpox globally. Neustaedter argues that vaccination has eradicated smallpox across the world, thus, facilitating discontinuation of routine immunization for the disease (2). Potentially, vaccination can also eradicate other infectious ailments as long as specific diagnosis and effective vaccines are available. Nonetheless, complete eradication needs high levels of population immunization across the globe over a long time with sufficient surveillance.

Polio is the next target disease for eradication. This is one of the leading causes of disabilities throughout the world. Disabled people become vulnerable to other health complications and might die at early ages. Quadros is concerned that despite the fact that increased immunization for oral polio vaccine has significantly reduced cases of type 2 poliovirus across the globe, transmission of types 3 and 1 persists in some countries (1-3). Those opposed to vaccination claim that oral polio vaccine sometimes causes paralysis diseases. This is a critical observation. Neustaedter agrees that paralytic diseases are associated with oral polio vaccine excretion, especially in immune-deficient people who have not yet been addressed (236). Therefore, the use of monovalent type 3 and 1 oral polio vaccine, as well as inactivated polio vaccine globally, might be required.

Elimination

Vaccinations also eliminate various diseases, thus, allowing people to live longer lives. Andre et al. insist that societies can eliminate diseases locally without eradicating the causative microorganism globally (1). In 4 out of 6 World Health Organization areas, significant progress has been made to eliminate measles. As such, the transmission has reduced significantly and “importation does not occur in sustained spread of the disease” (Andre et al. 1). The key to this accomplishment is nearly 95 percent population immunity using a two-dose vaccination schedule.

A joint measles, mumps, and rubella vaccine also eliminates and ultimately eradicates mumps and rubella. According to Andre et al., the increasing level of measles immunization in Africa which averaged only 67 percent in 2004 is sufficient for suppression of these diseases (1). Andre et al. report indicated that vaccination has already eliminated measles, rubella, and mumps in Finland and measles in the U.S. (1). This is a clear indication of the practicality of vaccination eradicating the diseases globally. As such, it is also possible for vaccination to eliminate other diseases, such as Haemophilus influenza type d infection, through properly implemented national programs as evident in the West.

Opponents might argue that it is not possible to eliminate measles, mumps, or rubella completely. This is an important observation especially if the vaccination program is not conducted globally. Andre et al. acknowledge that local elimination of the diseases does not clear the danger of reintroduction (1). For example, Botswana had been polio-free since 1991. However, the disease emerged again in 2004 after importation of type 1 poliovirus from Nigeria. A traveler from India also reintroduced measles in the U.S. in 2005. Nevertheless, global elimination can prevent reintroduction and prolong many lives in the society.

Economic Impact of Vaccinations

Vaccination is a cost-effective and successful medical intervention ever introduced. According to Whitney et al., investment in vaccination helps to save money which people can use to buy balanced diet foods essential for living long life (352-353). Ehreth asserts that “Healthcare intervention is cost-effective if it buys a year of healthy life for less than per capita GNP of the country” (599). Immunization costs approximately $50.00 per healthy life year saved, thus, making it cost-effective. This comparison is valid because the cost of treating a health problem, such hypertension ranges from “$4,340 to $87,940 per healthy life year saved” (Ehreth 599). Therefore, when infectious illnesses are not treated on time, they can cost the society a lot of money.

Vaccination helps the society to save a lot of money directly. The table summarizes the approximate amount of money the society saves through vaccination against different diseases.

Table 1: Cost Saved through Vaccination in the U.S.

Disease

Comparative Cost Saved

Indirect or Direct Savings

MMR

For every $1 used for MMR vaccine, nearly $21 is saved directly out of medical care cost

$100M saved directly in medical cost between 1989 and 1991 due to outbreak of measles

Measles

A single case of measles is about 23 times the budget for vaccinating one person against the disease

$10 for every disability-adjusted life year (DALY)

Hib

For every $1 spent on vaccination against Hib, nearly $2 is saved

5 billion U.S. dollars direct cost and about $12 billion indirect cost incurred in the U.S.

DTPa

For every $1 used on DTPa vaccine, approximately $24 is saved

About $23.6 billion in indirect and direct cost without DTP vaccine

Polio

Not available

$700 million in the U.S. from 1991 to 2000.

$13.6 billion in total saving globally by 2040

Smallpox

Not available

$300 million in direct cost saved per year

Source: Ehreth (598)

The table indicates that vaccination helps the economy to save a lot of money that people would incur if they do not vaccinate their children. In turn, people can use the money saved to improve dietary, thus, leading to healthy living. For example, there is a significant return on investment for the vaccines. According to Ehreth, between $3.94 and $4.91 is saved per dollar used on MMR vaccine (599). Notably, this is the approximate cost saved without considering improved productivity and reduced absenteeism. Accounting for the indirect cost saved will lead to huge money saved.

Further research shows that the yearly “cost of immunizing millions of children against 6 infectious diseases is equal to the cost of one day of health care in the U.S.”(Ehreth 599). Fortunately, for less than $20 in administration and vaccine costs, one person can be immunized against pertussis, polio, tetanus, measles, and diphtheria. Most importantly, additional “life-saving” vaccine can be acquired for less than $10 per vaccine (Ehreth 599). Simple arithmetic is that if it costs about $30 to immunize 1 child, this will translate to about $3 to $4 billion annually to immunize more than 120 million children. Ehreth clarifies that the coverage of measles vaccine can be increased to more than 95% at the cost of $2.9 billion in low-income countries (599). This program lead can prevent deaths of more than 579,000 children per year.

Ideally, immunization is the gateway to economic development. The figure shows a virtuous cycle relating immunization to economic development.

Figure 1: Virtuous Cycle

The figure shows that vaccination has numerous indirect economic benefits for the family and the entire economy. The benefits range from reduced cost of health to economic growth through improved savings (Mirelman, Sachiko, and Simrun 454-456).

Vaccinations and Autism

Those opposed to the use of vaccines believe that they contain harmful ingredients. A common argument against vaccinations is that they cause or increase risks of developing autism. However, there is no medically verifiable link between autism and vaccines implying that such claims are based on hearsay and are not true (Worth 1-2). First thing, it is important to understand the causes of autism disorder. Worth defines autism as a developmental disorder that occurs in early ages and affects the brain (1-2). The disease impairs communication and social interaction. This health problem affects many children and has no cure. It was found that 1 in every 68 children born in the U.S. in 2002 had autism (2-4). It is important to bear in mind that this is a psychological disorder, thus, it has not definitive medical tests. The diagnosis of autism includes observation of individual’s communication, social interaction, and interests.

Parents want the best for their children, including long and healthy life, which can make diagnosis of autism a hard thing for them to address. Indeed, most parents are not concerned about what entails autism and how they developed the disorder. Such information would minimize misunderstandings associated with the disease in relation to vaccination. Notably, vaccines are given at the same age when autism can be developed, thus, leading to the speculation that vaccines cause autism.

Although there are many vaccines, thus, making it hard for people to understand what each of them contains, it is important to understand components of the commonly used vaccines. Such information will clear doubt and increase societal acceptance of the vaccines by allowing people to make informed decisions. Some of the ingredients in common vaccinations which most people speculate include Thimerosal. This is a mercury-based substance which is harmful to central nervous system, especially if taken in high doses (Volkmar, Rhea, and Ami 1-3). High doses of mercury also cause behavioral changes, such as lack of coordination and irritability, when exposed to high temperatures. These changes are similar to autism symptoms. However, the ingredient was removed from all the child vaccines in 2001, except in one type of influenza vaccine to facilitate further research (Volkmar, Rhea, and Ami 3). The table shows common vaccines and their main ingredients.

Table 2: Vaccines and their Components

Vaccine

Ingredients

BCG (Tice)

Citric acid, magnesium sulfate, asparagines, potassium phosphate, glycerin, lactose, and iron ammonium citrate

Anthrax or biothrax

Benzethonium chloride, aluminum hydroxide, amino acids, formaldehyde,

vitamins, and inorganic salts

Hepatitis B (Comvax)

Yeast, hemin chloride, dextrose, soy peptone, mineral salts, amino

acids, potassium aluminum sulfate, formaldehyde, sodium borate, phenol, and enzymes

Hepatitis A (Vaqta)

Bovine albumin, aluminum hydroxyphosphate sulfate, neomycin,

formaldehyde, and sodium borate

Human Papillomavirus

(HPV) or Cerverix

Amino acids, vitamins, mineral salts, lipids, aluminum hydroxide, sodium

dihydrogen phosphate dehydrate, bacterial and viral protein

Human Papillomavirus

(HPV) or Gardasil 9

Vitamins, yeast protein, mineral salts, amino acids, carbohydrates,

amorphous aluminum hydroxyphosphate sulfate, sodium borate, and polysorbate

80

MMR-II

Vitamins, fetal bovine serum, amino acids, sucrose,

glutamate, phosphate, neomycin, sorbitol, and hydrolyzed gelatin

Pneumococcal or PCV13 –

Prevnar 13

Ammonium sulfate, casamino acids, Polysorbate 80, yeast, succinate

buffer, and aluminum phosphate

Polio or IPV–Ipol

Formaldehyde, neomycin, streptomycin,

monkey kidney cells, and calf serum protein

Rabies or Imovax

Neomycin sulfate, human albumin, and beta-propriolactone

Varicella or Varivax

Sucrose, glutamate, phosphate, gelatin, sodium

phosphate dibasic, potassium chloride, potassium phosphate monobasic,

sodium phosphate monobasic, MRC-5 cells components including protein and DNA neomycin, and fetal

bovine serum

cell cultures, human embryonic lung cultures

Rabies (RabAvert)

Potassium glutamate, chicken and egg protein,

neomycin, human serum albumin, chlortetracycline, amphotericin B,

polygeline, and bovine serum

Influenza (Fluvirin)

Thimerosal, neomycin, egg protein, beta-propiolactone, and

phosphate buffer

Source: CDC (1-4)

Although the table does not include all the components of the listed vaccines, it is clear that the vaccines do not consist of harmful ingredients, especially Thimerosal. Moreover, some of the components, such as sugar and salt, have low adverse impacts compared to effects of the diseases a child might contract by failing to take the vaccines.

Those opposed to the use of mumps, measles, and rubella (MMR) vaccine base their argument on Lancet’s study conducted a few years ago. However, this study was not only based on a small sample but also had adequate supporting evidence. First and foremost, the study was based only on 12 children, 11 boys and 1 girl (Herlihy and Hagood 83). A study based on such small sample size should not be generalized for a phenomenon that has global impact. In most cases, when a study relies on a small number of people, it ends up with outcome which cannot be obtained when the study is repeated with a large number of people. This process is called replication and is vital for determining the validity of scientific research outcomes. Those interests in the link between autism and MMR vaccine needs to replicate the study using more subjects.

The other feature that makes the results of Lancet’s flawed is the process used to choose the items. A researcher should use recommended methods, such as random sampling, to avoid biases. However, the study on which Lancet report was based focused on children who had digestive disorders, whose parents indicated that they showed development regression shortly after MMR vaccine, and who had been diagnosed with autism (Herlihy and Hagood 84). This sampling method was biased, thus, the end results were also unreliable. That is the researcher chose subjects who had variables in which he was interested. In other words, the study used cases where variables had already been established. Therefore, those who feel that vaccines cause autism should first understand where the myth originated.

Another study conducted in 2011 by Dr. Andrew Wakefield increased concern that vaccinations increased chances of contracting autism. However, the survey was retracted and termed as a “fraud” which has done long-lasting harm to the public health (Volkmar, Rhea, and Ami 1-3). Having basic information about how some of the misconceptions came up will help parents make informed decisions whether to vaccinate their children or expose them to myriad of diseases which might cut their lives short. Wakefield’s study claimed that children developed symptoms related to autism once received the vaccination (Volkmar, Rhea, and Ami 1-3). However, it is worth noticing that the children used in the study already had autism symptoms prior to vaccination. As such, the study was intentionally falsified to create unnecessary drama associating vaccines with autism. Overall, vaccination does not cause autism because no scientific study has linked the two.

Religion and Vaccinations

Some countries exempt children from some families from compulsory vaccinations on religious basis. For example, in the state of Oregon, a family can allege a religious exemption so that its children do undergo vaccination. Indeed, one does not have to prove a declaration to the religion to be exempted from vaccination. Those supporting religious exemptions to vaccinations base their arguments on various claims. First thing, they point that the free-exercise clause provided under the First Amendment requires state to accommodate members of religious groups who oppose vaccinations on religious basis (McFall 1). From their point of view, requiring children to receive vaccination contrary to their religious beliefs and practices place undue burden on their free-exercise rights.

Although these are sound arguments, vaccination opponents seem to overlook the point that vaccines are meant to protect recipients and lengthen their life implying that it still serves their rights. McFall supports this perspective by adding that the Constitution recognizes that the country has compelling interests in regulating and protecting people’s health (1). Such interest justifies vaccination of all the children without exemptions. From the perspective of public health experts, vaccinations have significantly increased the society’s capability to prevent diseases, especially in children (McFall 1). One proof of this improvement is eradication of a number of deadly illnesses, such as smallpox, and near-eradication of others, such as anthrax.

Although the threat of outbreak of other diseases, such as polio, has not been eliminated completely, religious exempted will do more harm than benefits to the society by sparkling some deadly infections which can be prevented through an all-encompassing vaccination requirement (McFall 1). For instance, the measles outbreak that occurred in 1991 in the Faith Tabernacle community in Pennsylvania could have been prevented if the children had been vaccinated. This community requested to be exempted and it was granted the exemption from compulsory measles vaccination for their children in public schools. Unfortunately, the outbreak of the disease led to the death of six children in the community (McFall 1). As such, it is evident that religious exemptions decrease the community’s immunity and increase risks of deadly outbreak.

Those who advocate religious exemptions further argue that parents have constitutionally protected rights to decide whether to vaccinate their children or not (McFall 1). No one opposes the point that parents have the primary right to determine the upbringing and education of their children. Indeed, this argument was supported in the case between Wisconsin against Yoder in 1972. In that case, Amish family argued that compulsory secondary education was against the children’s right to free exercise, yet the community’s wellbeing depended on children remaining home from school to work and learn from the society (McFall para. 12).

Other exemption advocates question of the medical and legal necessity of vaccinations by noting that the legal proceeding that established nation’s right to require vaccination was inadequate and is now outdated. According to McFall, the state’s right to demand vaccination was established in 1905 Supreme Court decision in the case of Jacobson v. Massachusetts. Religious exemption proponents argue that the rate of smallpox infection was high and the danger the disease posed to the public could not be ignored (McFall para. 12). The court ruled that based on the severity of the illness, the state had the right to require vaccination of all the children. They add that currently no disease prevented by vaccination that poses a threat to public health is comparable to that posed by smallpox that year. Indeed, the threat of smallpox and other diseases has reduced over time due to vaccination. As such, the state should continue requiring vaccination of all the children, regardless of the religious differences to prevent reoccurrence of the diseases.

Moreover, granting religious exemption only to a particular religious or to those who have genuine and sincere religious distaste to vaccination fails the second point of the Supreme Court’s popular “Lemon” tests and, hence, breaches the First Amendment. That is, religious exemption favors one religion at the expense of the other, hence, violating the principle of strict neutrality (McFall para. 12). Compulsory vaccinations promote neutrality by requiring people from all the religious backgrounds to take the vaccines.

The other concern associated with religious exemption is that allowing some children to opt-out of the vaccination program undermines the “herd immunity” of public schools. McFall defines “herd immunity” as the phenomenon of general communities or population becoming immune to particular diseases because every member of that particular community has taken necessary step to prevent the disease (para. 13). Vaccination creates a large population of immune children in schools. Allowing new children to school who have been exempted from vaccination weakens the immunity of the school population. As the herd immunity declines, the risks of outbreak increase gradually. Therefore, allowing religious exemptions places the previously immune population in danger of deadly outbreak.

Those opposed to the use of mumps, measles, and rubella (MMR) vaccine base their argument on Lancet’s conducted some years ago. However, this study was not only based on inadequate sample, but also had adequate supporting evidence. First and foremost, the study was based only on 12 children, 11 boys and 1 girl (Herlihy and Hagood 83). A study based on such small sample size should not be generalized for a phenomenon that has global impact. In most cases, when a study is based on a small number of people, it ends up with outcome which cannot be obtained when the study is repeated with a large number of people. This process is called replication and is vital for determining the validity of scientific research outcomes. Similarly, those interests in the link between autism and MMR vaccine needs to replicate the study using more subjects.

The other feature that makes the results of Lancet flawed is the process used to choose the subjects. A research should use recommended methods, such as random sampling, to avoid biasness. However, the study on which Lancet report was based focused on children who had digestive disorders, whose parents reported that they showed development regression shortly after MMR vaccine, and who had been diagnosed with autism (Herlihy and Hagood 84). This sampling method was biased, thus, the end results were also unreliable. That is the researcher chose subjects who had variables in which he was interested. In other words, the study used cases where variables already had established correlation. Therefore, those who feel that vaccines cause autism should first understand where the myth originated and which was the basis of the study.

Another study conducted in 2011 by Dr. Andrew Wakefield increased concern that vaccinations increased chances of contrasting autism. However, the survey was retracted and termed as a “fraud” which has done long lasting harm to the public health. Having basic information about how some of the misconceptions came up will help parents make informed decisions whether to vaccinate their children or expose them to myriad of diseases which might cut their lives short. Wakefield’s study claimed that children developed symptoms related to autism once received the vaccination (Volkmar, Rhea, and Ami 1-3). However, it is worthy noticing that the children used in the study already had autism symptoms prior to vaccination. As such, the study was intentionally falsified to create unnecessary drama associating vaccines with autism.

Conclusion

Although some people still associate vaccinations with autism and often request the government to exempt them from compulsory vaccination, this public health intervention promotes longevity of the society by eradicating and eliminating some diseases, thus, protecting lives of people. Vaccinations and immunization also support societal economies by saving cost that would be incurred in the treatment of illness. Families save the money to buy food, pay school fees, or start businesses, thus, improving their financial status. As such, people should embrace the vaccination program for better future of their children.

Works Cited

Andre, Francis E., et al. “Vaccination Greatly Reduces Disease, Disability, Death and Inequity Worldwide.” Bulletin of the World Health Organization 86.2 (2008): 140-146.

CDC. Vaccine Excipient & Media Summary-Excipients Included in US Vaccines. http://www.cdc. gov/vaccines/pubs/pinkbook/downloads/appendices/b/excipienttable-2. Pdf. Accessed 21 February 2017.

Ehreth, Jenifer. ”The Global Value of Vaccination.” Vaccine 21.7 (2003): 596-600.

Herlihy, M. Stacy and Hagood E. Allison. Your Baby’s Best Shot: Why Vaccines Are Safe and Save Lives. London: Continuum, 2012.

McFall P. Shaun. Vaccination and Religious Exemptions. First Amendment Center, 18 Aug. 2008, http://www.firstamendmentcenter.org/vaccination-religious-exemptions/. Accessed 21 February 2017.

Mirelman, J. Andrew, Sachiko Ozawa, and Simrun Grewal. ”The economic and social benefits of childhood vaccinations in BRICS.” Bulletin of the World Health Organization 92.6 (2014): 454-456.

Neustaedter, Randall. The Vaccine Guide: Risks and Benefits for Children and Adults. Berkeley, Calif: North Atlantic Books, 2002.

Quadros, Ciro A. Vaccines: Preventing Disease & Protecting Health. Washington, D.C: Pan American Health Organization, 2004.

Rappuoli, Rino. ”Vaccines: Science, Health, Longevity, and Wealth.” Proceedings of the National Academy of Sciences 111.34 (2014): 12282-12282.

Romm, J. Aviva. Vaccinations: A Thoughtful Parent’s Guide: How to Make Safe, Sensible Decisions About the Risks, Benefits, and Alternatives. Rochester, Vt: Healing Arts Press, 2001.

Volkmar, Fred R, Rhea Paul, and Ami Klin. Handbook of Autism and Pervasive Developmental Disorders. Hoboken: John Wiley & Sons, 2005.

Whitney, Cynthia G., et al. ”Benefits from Immunization during the Vaccines for Children Program era—United States, 1994–2013.” MMWR Morb Mortal Wkly Rep 63.16 (2014): 352-355.

Worth, Sarah. Autistic Spectrum Disorders. London: Continuum, 2005.